Mini-Mental State Examination

1
Mini-Mental State Examination (MMSE)
Patient’s Name: Date:
Instructions: Ask the questions in the order listed. Score one point for each correct
response within each question or activity.
Maximum
Score
Patient’s
Score
Questions
5 “What is the year? Season? Date? Day of the week? Month?”
5 “Where are we now: State? County? Town/city? Hospital? Floor?”
3
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient’s response is
used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials: ___________
5
“I would like you to count backward from 100 by sevens.” (93, 86, 79,
72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
3
“Earlier I told you the names of three things. Can you tell me what those
were?”
2
Show the patient two simple objects, such as a wristwatch and a pencil,
and ask the patient to name them.
1 “Repeat the phrase: ‘No ifs, ands, or buts.’”
3
“Take the paper in your right hand, fold it in half, and put it on the floor.”
(The examiner gives the patient a piece of blank paper.)
1
“Please read this and do what it says.” (Written instruction is “Close
your eyes.”)
1
“Make up and write a sentence about anything.” (This sentence must
contain a noun and a verb.)
1
“Please copy this picture.” (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
30 TOTAL
(Adapted from Rovner & Folstein, 1987)
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf Provided by NHCQF, 0106-410

2
Instructions for administration and scoring of the MMSE
Orientation (10 points):
• Ask for the date. Then specifically ask for parts omitted (e.g., "Can you also tell me what season it
is?"). One point for each correct answer.
• Ask in turn, "Can you tell me the name of this hospital (town, county, etc.)?" One point for each
correct answer.
Registration (3 points):
• Say the names of three unrelated objects clearly and slowly, allowing approximately one second for
each. After you have said all three, ask the patient to repeat them. The number of objects the
patient names correctly upon the first repetition determines the score (0-3). If the patient does not
repeat all three objects the first time, continue saying the names until the patient is able to repeat all
three items, up to six trials. Record the number of trials it takes for the patient to learn the words. If
the patient does not eventually learn all three, recall cannot be meaningfully tested.
• After completing this task, tell the patient, "Try to remember the words, as I will ask for them in a
little while."
Attention and Calculation (5 points):
• Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93,
86, 79, 72, 65). Score the total number of correct answers.
• If the patient cannot or will not perform the subtraction task, ask the patient to spell the word "world"
backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3).
Recall (3 points):
• Ask the patient if he or she can recall the three words you previously asked him or her to
remember. Score the total number of correct answers (0-3).
Language and Praxis (9 points):
• Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score
one point for each correct naming (0-2).
• Repetition: Ask the patient to repeat the sentence after you ("No ifs, ands, or buts."). Allow only one
trial. Score 0 or 1.
• 3-Stage Command: Give the patient a piece of blank paper and say, "Take this paper in your right
hand, fold it in half, and put it on the floor." Score one point for each part of the command correctly
executed.
• Reading: On a blank piece of paper print the sentence, "Close your eyes," in letters large enough
for the patient to see clearly. Ask the patient to read the sentence and do what it says. Score one
point only if the patient actually closes his or her eyes. This is not a test of memory, so you may
prompt the patient to "do what it says" after the patient reads the sentence.
• Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do
not dictate a sentence; it should be written spontaneously. The sentence must contain a subject
and a verb and make sense. Correct grammar and punctuation are not necessary.
• Copying: Show the patient the picture of two intersecting pentagons and ask the patient to copy the
figure exactly as it is. All ten angles must be present and two must intersect to score one point.
Ignore tremor and rotation.
(Folstein, Folstein & McHugh, 1975)

3
Interpretation of the MMSE
Method Score Interpretation
Single Cutoff <24 Abnormal
Range
<21
>25
Increased odds of dementia
Decreased odds of dementia
Education
21
<23
<24
Abnormal for 8th
grade education
Abnormal for high school education
Abnormal for college education
Severity
24-30
18-23
0-17
No cognitive impairment
Mild cognitive impairment
Severe cognitive impairment
Sources:
• Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state
examination by age and educational level. JAMA. 1993;269(18):2386-2391.
• Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state
of patients for the clinician. J Psychiatr Res. 1975;12:189-198.
• Rovner BW, Folstein MF. Mini-mental state exam in clinical practice. Hosp Pract. 1987;22(1A):99, 103, 106,
110.
• Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc.
1992;40(9):922-935.

Mini-Mental State Examination

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